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17 Cards in this Set
- Front
- Back
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What are the two sources of hepatic blood flow?
Which is oxygen-rich, nutrient poor? Which is o2-poor, nutrient rich? Which is the main source of blood for the liver? |
Hepatic artery (main)
Portal Vein |
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Statistically speaking, what is the most common cause of jandice in young adults? The Elderly?
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Viral Hepatitis
Malignancy |
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What are the two things bile is used for in the body?
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- Promoting digestion and absorption of dietary lipids
- Allowing excretion of lipid organic metabolites and drugs not readily eliminated through the kidneys |
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If necessary, liver can increase synthesis of bile acids up to __ times normal.
__% of bile acids are reabsorbed in the terminal ileum, then extracted from the portal circulation by hepatocytes. |
10
95% |
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Do most gallstones cause sx?
What are the two types of gallstones, and what is the breakdown of one of those types? Of which type are 80% of stones? What are the 4F's, and what do they put you at risk for? |
No. 80% don't.
Cholesterol & Pigmented (Black and Brown) Cholesterol Fat, Fertile, Female, Forty - cholesterol stones! |
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On which three factors do gallstone formation depend?
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supersaturation of bile
a nidus for cholesterol crystal formation gallbladder dysmotility/bile stasis |
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What differentiates the composition of black vs brown stones?
Which is more important in infections? |
Black: calcium bilirubinate
Brown: Ca-bilirubinate + FFA from breakdown of lecithin by bacteria Brown |
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Define the following terms:
Cholelithiasis Biliary colic Cholecystitis Choledocholithiasis Cholangitis |
Cholelithiasis – stones in the gallbladder
Biliary colic – intermittant RUQ pain, can be a sign of obstruction Cholecystitis - infec of gallbladder Choledocholithiasis – stone in common bile duct Cholangitis – infection of bile duct |
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Why might pain caused by gallstones selectively show up after eating? What is this pain called?
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gallbladder contracts after eating --> temporary obstruction / pain of contraction on the stone --> biliary colic
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In Cholecystitis, what type of LFTs would you expect to see? WBC count?
Would you see Jaundice? Tx of choice? |
LFTs = normal
Elevated WBC No; if you see jaundice, then something else is going on instead/with. Cholecystectomy, antiB |
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Fever & Murphy's sign, in a pt with normal LFTs, elevated WBC, and no jaundice... what should we think of?
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Cholecystitis
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If the pt's stool is acholic ("clay-colored"), and their urine is dark, "tea-colored", what pathophysiology might we think of?
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obstruction of the bile duct.
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What is Charcot's triad? What is it the classical presentation of?
Is it an emergent condition? |
fever
right upper quadrant pain jaundice obstruction of the flow of bile Yes. |
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List the status of the following parameters for these four dz (Cholelithiasis, Cholecystitis, Choledocholithiasis, Cholangitis):
- Sx - Fever + elevated WBC - LFTs - Biliary dilation on ultrasound - Tx? |
Cholelithiasis:
- biliary colic, No, normal, no, surgery if sx exist Cholecystitis: - biliary colic / RUQ pain, Yes, Normal, No, Surgery + antiBs Choledocholithiasis: - billiary colic / RUQ pain, Either, Elevated (AP, GGT, Bili), yes, ERCP Cholangitis: - RUQ pain, yes, all elevated, either, ERCP + AntiB |
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Ultrasound is _____ and ____ for detecting cholelithiasis.
Can U/S dx cholecystitis? |
sensitive and specific
No, but it can suggest it. |
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IV radio-nucleotides concentrate in the bile and collect in the GB
If GB doesn’t appear, what does that mean? As a corollary, what acute issue is this scan great for dx'ing? |
cystic duct must be obstructed
Great way to dx acute cholecystitis |
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Think about what ERCP and MRCP are, and what there differences are.
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ERCP = Endoscopic retrograde cholangiopancreatography
MRCP = non-invasive, almost as good |
